Hospital In Manhattan Research Articles

Increasing Accrual of Racial and Ethnic Minorities in Breast Cancer Clinical Trials by Partnering with Community Hospitals

Clinical trials provide the highest level of evidence in evaluating the safety and efficacy of new radiation approaches for breast cancer. However, there is a significant lack of racial and ethnic diversity among participants who are enrolled. This discrepancy in research inclusion leads to limitations in applying clinical data, therapeutic indices, technique safety, and toxicity to a diverse patient population. A community-based approach, such as the inclusion of community hospitals in trial enrollment, has been shown to boost participation within these underserved populations. The aim of this study was to evaluate the rate of enrollment of racial and ethnic minorities in breast cancer clinical trials with the inclusion of community hospitals within an NYC hospital system. Trial enrollment of breast cancer patients at 3 hospitals was retrospectively assessed. Patient demographics, including age, race, and ethnicity, were compared by enrollment setting. Eligible trials included prospective, randomized clinical trials assessing breast cancer irradiation. Participating hospitals included an academic hospital in Manhattan (MH), and 2 community hospitals in Brooklyn (BH) and Queens (QH). Collectively, these hospitals have a catchment area of 6.2 million, of which 35.2% are White, 19.7% are Asian, 18.3% are Black/African American (B/AA), and 21.2% are Hispanic/Latino (H/L). There is a wide demographic variety within this catchment area. BH serves neighborhoods with a B/AA population as high as 85% and QH serves neighborhoods with an Asian population as high as 54%. From January to December 2022, 146 patients were enrolled in 4 breast cancer trials opened at MH (59.6%, n = 87), BH (28.8%, n = 42), and QH (11.6%, n = 17). The average age was 63.3 (SD = 12.1). Of all patients enrolled, 52.7% identified as White, 23.2% as B/AA, 13% as Asian, and 8.9% as H/L. Of the patients enrolled at MH, 64.4% identified as White, 12.6% as B/AA, 8% as Asian, and 8% as H/L. At BH, 50% identified as B/AA, 38% as White, 4.7% as Asian, and 11.9% as H/L. At QH, 58.8% identified as Asian, 29.4% as White, and 11.8% as B/AA. B/AA (OR = 4.41, 95% CI, 1.94-10.03; p<.01) and Asian (OR = 2.92, 95% CI, 1.07-7.93; p<.05) patients were more likely to be enrolled at a community hospital when compared to an academic hospital. There was no difference in enrollment rates between campuses for H/L patients (OR = 1.29, 95% CI, 0.41-4.06; p = .66). Enrollment of participants from underrepresented racial and ethnic populations in clinical trials is critical to ensuring health equity. These findings suggest partnerships with community hospitals located in underserved populations can be a strategy to improve diversity among clinical trial participants. As it is well-documented that community hospitals can deliver high quality research with similar trial metrics to larger, academic hospitals, partnerships with community hospitals are a feasible way to reduce disparities in breast cancer research.

Chronotype and sleep duration interact to influence time to pregnancy: Results from a New York City cohort

Study objectiveTo study associations between nighttime sleep characteristics and time to pregnancy. MethodsPregnant people age ≥18 years and<18 weeks’ gestation were recruited from 3 New York University Grossman School of Medicine affiliated hospitals in Manhattan and Brooklyn (n = 1428) and enrolled into the New York University Children’s Health and Environment Study. Participants in the first trimester of pregnancy were asked to recall their time to pregnancy and their sleep characteristics in the 3 months before conception. ResultsParticipants who reported sleeping<7 hours per night tended to have shorter time to pregnancy than those who slept 7-9 hours per night (adjusted fecundability odds ratio = 1.16, 95% confidence interval: 0.94, 1.41). Participants with a sleep midpoint of 4 AM or later tended to have longer time to pregnancy compared with those with earlier sleep midpoints (before 4 AM) (adjusted fecundability odds ratio = 0.88, 95% confidence interval: 0.74, 1.04). When stratified by sleep midpoint, sleeping<7 hours was significantly associated with shorter time to pregnancy only among those whose sleep midpoint was before 4 AM (adjusted fecundability odds ratio = 1.33, 95% confidence interval: 1.07, 1.67). ConclusionsThe association of sleep duration with time to pregnancy was modified by chronotype, suggesting that both biological and behavioral aspects of sleep may influence fecundability.

Abstract TP168: Stroke Risk Among Those With Prior Healthcare Associated Infections: A Case Control Study

Introduction: Younger age groups demonstrate greater heterogeneity in stroke etiology compared to the older stroke population. Identifying novel risk factors in this population is a high priority. Methods: Our study utilized patient data from three urban Manhattan hospitals and one community hospital outside of Manhattan. Cases were adults with a stoke admission. Controls were adults with a trauma or orthopedic admission randomly matched 2:1 to cases on date of admission. Odds of stroke following an infection during the prior year as compared to those with no infection was assessed using unadjusted logistic regression and as a time-varying analysis using unadjusted and adjusted generalized estimating equations controlling for time, age, sex, race, hypertension, diabetes, renal failure Results: Our study included 8,983 stroke cases and 17,966 matched controls with a mean age of 68.9 and 61.2 years, respectively. Of cases 50.6% were female. 28.8% were non-Hispanic white, 31.4% had diabetes, 61.7% had hypertension and 21.7% had renal failure. Of controls, 50.1% were female, 30.7% were non-Hispanic white, 15.3% had diabetes, 36.1% had hypertension and 15.1% had renal failure. Within the 1 year prior, 21.5% of cases and 14.5% of controls had an infection. Those with an infection in the year prior had increased odds of stroke when compared to those with no infection (Table 1) with the greatest effect size seen in those ≤45 years old. Conclusions: Odds of stroke increases following a hospital-acquired infection, particularly in the young population. Odds by type of infection will be presented.

The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines

The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines

Influence of Socioeconomic Factors on Surgical Wait Times for Elective Surgeries in Benign Gynecology [A81

INTRODUCTION: In various disciplines, an association between patient outcomes and surgical wait times has been identified. This study provides the first investigation into whether practice setting influences wait times for elective surgeries in benign gynecology. METHODS: This retrospective study of patients at three Manhattan hospitals from October 2019 to February 2020 compared surgical wait times among patients seen in federally qualified health centers (FQHC) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of procedure. A multivariable mixed model was used to model the log of surgical wait time by setting of care, adjusting for age, body mass index (BMI), race/ethnicity, insurance, need for medical clearance, and scheduled block time. RESULTS: A total of 540 patients were identified with a median age of 45.6 years (range 16-87 years). Average surgical wait time was 27 days (range 1-288 days). In multivariate analysis, longer surgical wait times were associated with the FQHC setting relative to private practice (70.9% longer, P=.006), and with needing medical clearance (36.8% longer, P=.02). Insurance type and race/ethnicity did not significantly impact surgical wait times in multivariate analysis. In univariate analysis, patients with public insurance had longer wait times compared with patients with commercial insurance (25% longer, P=.03). CONCLUSION: These results suggest that in benign gynecology, surgical wait times are significantly influenced by practice setting. Further research should investigate the reasons behind these preoperative delays with the goal of correcting inequities inherent in the medical system.

Predictors of biliary intervention in patients hospitalized for COVID-19.

BackgroundGastrointestinal complications of coronavirus disease-2019 (COVID-19) include abnormal liver function and acalculous cholecystitis. Cholecystostomy performed during the COVID-19 pandemic reflected a shift toward non-surgical treatment of cholecystitis and increased number of critically ill patients suffering from acalculous cholecystitis.Purpose(1) To determine demographic, clinical, laboratory, and ultrasound features associated with cholecystostomy placement during hospitalization for COVID-19. (2) To develop multivariable logistic regression modeling for likelihood of biliary intervention.MethodsThis retrospective review received institutional review board approval. Informed consent was waived. Between March 2020 and June 2020, patients with confirmed SARS-CoV2 infection admitted to New York-Presbyterian Hospital (NYP)/Weill Cornell Medical Center, NYP/Lower Manhattan Hospital, and NYP/Queens were evaluated for inclusion in this study. Inclusion criteria were (1) patient age ≥ 18, (2) confirmed COVID-19 infection by polymerase chain reaction testing of a nasopharyngeal swab, and (3) abdominal ultrasound performed during hospitalization. Exclusion criteria were (1) history of cholecystectomy and (2) biliary intervention performed prior to abdominal ultrasound. Patients were stratified into two groups based on whether they received cholecystostomy during hospitalization. Differences in demographics, medical history, clinical status, medications, laboratory values, and ultrasound findings between the two groups were evaluated using Chi-square test or Fisher’s exact test for categorical variables and t test or Wilcoxon-rank sum test for continuous variables. Multivariable logistic regression was used to model likelihood of biliary intervention.ResultsNine patients underwent cholecystostomy placement and formed the “Intervention Group.” 203 patients formed the “No Intervention Group.” Liver size and diuretics use during hospitalization were the only variables which were significantly different between the two groups, with p-values of 0.02 and 0.046, respectively. After controlling for diuretics use, the odds of receiving cholecystostomy increased by 30% with every centimeter increase in liver size (p = 0.03). ICU admission approached significance (p = 0.16), as did mechanical ventilation (p = 0.09), septic shock (p = 0.08), serum alkaline phosphatase level (p = 0.16), and portal vein patency (0.14).ConclusionPatients requiring biliary intervention during hospital admission for COVID-19 were likely to harbor liver injury in the form of liver enlargement and require diuretics use.

Hospital factor and prognosis of COVID-19 in New York City, the United States of America: insights from a retrospective cohort study

BackgroundApril 22nd, 2020, New York City (NYC) was the epicenter of the pandemic of Coronavirus disease 2019 (COVID-19) in the US with differences of death rates among its 5 boroughs. We aimed to investigate the difference in mortality associated with hospital factors (teaching versus community hospital) in NYC.DesignRetrospective cohort study.MethodsWe obtained medical records of 6509 hospitalized patients with laboratory confirmed COVID-19 from the Mount Sinai Health System including 4 teaching hospitals in Manhattan and 2 community hospitals located outside of Manhattan (Queens and Brooklyn) retrospectively. Propensity score analysis using inverse probability of treatment weighting (IPTW) with stabilized weights was performed to adjust for differences in the baseline characteristics of patients initially presenting to teaching or community hospitals, and those who were transferred from community hospitals to teaching hospitals.ResultsAmong 6509 patients, 4653 (72.6%) were admitted in teaching hospitals, 1462 (22.8%) were admitted in community hospitals, and 293 (4.6%) were originally admitted in community and then transferred into teaching hospitals. Patients in community hospitals had higher mortality (42.5%) than those in teaching hospitals (17.6%) or those transferred from community to teaching hospitals (23.5%, P < 0.001). After IPTW-adjustment, when compared to patients cared for at teaching hospitals, the hazard ratio (HR) and 95% confidence interval (CI) of mortality were as follows: community hospitals 2.47 (2.03-2.99); transfers 0.80 (0.58-1.09)).ConclusionsPatients admitted to community hospitals had higher mortality than those admitted to teaching hospitals.

932. Clinical Characteristics of Persistent and Relapsing Babesiosis at an Academic Medical Center in New York City, 2015-2020

Abstract Background Current guidelines recommend at least 6 weeks of therapy for immunocompromised babesiosis patients; however, limited data exists to guide management in this population. We describe our institutional experience with immunocompromised babesiosis patients. Methods We reviewed all adult patients reported to the New York City Department of Health and Mental Hygiene with a diagnosis of babesiosis at New York-Presbyterian (NYP)/Weill Cornell Medical Center and NYP/Lower Manhattan Hospital between 2015 and 2020. We compared characteristics and outcomes between patients receiving prolonged treatment (≥ 6 weeks; “cases”) and standard treatment (7-10 days; “controls”). Variables were compared using Fishers exact test or Wilcoxon Rank Sum test. Results Among 35 patients diagnosed with babesiosis, 10 (29%) received at least 6 weeks of therapy. 5/10 (50%) received extended treatment due to persistent and/or relapsing parasitemia, evidence of hemolysis and/or clinical symptoms at 6 weeks from diagnosis (Table 1). The median age was 67 years and immunocompromising conditions included: anti-CD 20 therapy (40%), history of stem cell transplant (20%), anti-TNF alpha (10%), beta-thalassemia (10%), Waldenstrom’s macroglobulinemia (10%). Among case patients, the median treatment duration was 53 days (IQR 42-153) and 100% of patients received azithromycin/atovaquone based regimens with adjunctive agents including doxycycline (60%), clindamycin (20%) and proguanil (20%). Compared to control patients, case patients had higher frequency of blood transfusions (50% vs 12%; p=0.03), however, there was no difference in median peak parasitemia (1.13% vs 0.6%), rates of hospital admission (80% vs 88%), length of stay (6 vs 4 days), organ dysfunction (10% vs 4%) and mortality (0% vs 0%) (Table 2). Conclusion We found a high frequency (29%) of babesiosis patients at our medical center received at least a 6-week treatment course due to immunocompromising conditions. Although immunocompromised patients received longer treatment courses and had more severe anemia, in contrast to prior studies, we found other complications such as hospitalization rates, length of stay, organ dysfunction and mortality were comparable between both patient groups. Disclosures Lars Westblade, PhD, Accelerate Diagnostics Inc (Grant/Research Support)BioFire Diagnostics (Grant/Research Support)Hardy Diagnostics (Grant/Research Support)Roche (Consultant, Advisor or Review Panel member)Shionogi Inc (Advisor or Review Panel member)Talis Biomedical (Advisor or Review Panel member)

Review: Rise of the Modern Hospital: An Architectural History of Health and Healing, 1870–1940

Review: <i>Rise of the Modern Hospital: An Architectural History of Health and Healing, 1870–1940</i>

From “sepulchral city” to “open city”: Hetero-images of Brussels in Joseph Conrad and Teju Cole

ABSTRACT Although Brussels does not figure as prominently in literature in English as do the more iconic cosmopolitan cities of London and New York, when the flâneur-narrator of Open City (2011) keeps up his ambulatory habits in the Belgian capital during a brief holiday from his psychiatry residency at a Manhattan hospital, Teju Cole joins a long line of authors from across the world who have drawn inspiration from Brussels (Acke and Bekers, eds., Brussel schrijven/ Écrire Bruxelles). With his “hetero-images” (Leerssen, “Imagology”), the Nigerian American writer follows the example of other Anglophone authors, including William Makepeace Thackeray, Charlotte Brontë, and Joseph Conrad, who have captured Brussels from the perspective of the “Other.” Comparing Cole's Open City with Conrad's much older discussion of the impact of Europe's cross-Atlantic imperialism in Heart of Darkness (1899/1902), this article argues that the fictionalizations of Brussels in both texts serve the authors’ self-reflective socio-criticism, whether it is a modernist critique on colonization or a postmodernist and postcolonial reading of the present-day multicultural world, rather than contribute to the proliferation of any transcendent myth concerning Brussels.

Utilizing Telemedicine in a Novel Approach to COVID-19 Management and Patient Experience in the Emergency Department.

Background: The COVID-19 crisis has highlighted telemedicine as a care delivery tool uniquely suited for a disaster pandemic. Introduction: With support from emergency department (ED) leadership, our institution rapidly deployed telemedicine in a novel approach to large-scale ED infectious disease management at NewYork-Presbyterian/Weill Cornell Medical Center (NYP/WCMC) and NewYork-Presbyterian/Lower Manhattan Hospital (NYP/LMH). Materials and Methods: Nineteen telemedicine carts were placed in COVID-19 isolation rooms to conserve personal protective equipment (PPE) and mitigate infectious risk for patients and providers by decreasing in-person exposures. Results: The teleisolation carts were used for 261 COVID-19 patient interactions from March to May 2020, with 79% of overall use in March. Our urban academic site (NYP/WCMC) had 173 of these cases, and the urban community hospital (NYP/LMH) had 88. This initiative increased provider/patient communication and attention to staff safety, improved palliative care and patient support services, lowered PPE consumption, and streamlined clinical workflows. The carts also increased patient comfort and reduced the psychological toll of isolation. Discussion: Deploying customized placement strategies in these two EDs maximized cart availability for isolation patients and demonstrates the utility of telemedicine in various ED settings. Conclusions: The successful introduction of this program in both academic and urban community hospitals suggests that widespread adoption of similar initiatives could improve safe ED evaluation of potentially infectious patients. In the longer term, our experience underscores the critical role of telemedicine in disaster preparedness planning, as building these capabilities in advance allows for the agile scaling needed to manage unforeseen catastrophic scenarios.

Cannon Fodder: A doctor on the front lines

106 essay Cannon Fodder A doctor on the front lines Laura Kolbe War and peace is making a comeback this spring, along with other great fat books, book clubbing in general, twelve-­ bean soups, and other projects meant to reac­ quaint us with a more glacial, less contemporary sense of time. When I think of War and Peace now, though, my mind strays from the Rostovs and Bezhukovs to Charles Joseph Minard’s graphs of Napoleon’s invasion of Russia. Minard was a nineteenth-­ century French civil engineer esteemed for his data-­ rich but immediately apprehensible diagrams of everything from commuter traffic to wine imports. His most famous and damning image, however, maps the progress of the Napoleonic army as it staggered west from Russia back to central Europe. Soldiers’ lives are initially a thick red band, a gash of enormous and emphatic force. Each mil­ limeter of red width stands for ten thousand men. As the march Cannon Fodder | 107 continues, the red band dwindles, etiolates. By the end of the cam­ paign only a small stream trickles back to safely held territory. As a child, I went to a somewhat old-­ fashioned Catholic school where history was largely understood as the study of military bat­ tles and their outcomes. This kind of education leaves much out, but helps me recognize a Minardian or Napoleonic situation when I see one. It’s becoming rapidly apparent that I, an internal medi­ cine doctor based at two academic hospitals in Manhattan, am part of the thick red band that’s about to be wrung threadbare. In the Trump administration’s United States, COVID-­ 19 has always been about commodities—that is, their scarcity. First there weren’t nearly enough tests, and the available tests were sporadi­ cally employed and sluggish to yield results. Then there were too many probable cases for it to be practicable to test widely, and besides, we somehow ran out of the swabs compatible with the test assays (just as there were finally almost enough of the latter). I’m speaking in the national “we,” and in particular the New York “we.” Here in New York City we’ve mostly stopped testing all but the severely ill sick enough to need a hospital bed—it would be a waste of precious swabs. While we worried about tests and swabs, we ran out of personal protective equipment (PPE) for health care workers. Over the last two weeks my hospital’s stock of gowns, gloves, masks, and face shields visibly dwindled in every cabinet. Eventually you had to know who to ask about secret cabinets, small locked stashes. It helped to whisper; it helped to have friends. My head was full of combination codes for various locked drawers and closets around the hospital. Then even the locked chambers started to empty. Every day we are told that a modest quantity of new supplies is almost here, but every day they’re not quite here. Ditto for ventilators. There is now a growing array of formal and informal protocols for cleaning, reusing, stretching, and sharing everything from masks to rooms and ventilators, all of them inge­ nious but admittedly not quite as good as the gold standards for worker safety or patient care. This is ubiquitous in all hospitals in our region, with mine in fact faring better than most. In addition 108 | Laura Kolbe to finding or reusing scarce equipment, new aspects of my job include lengthy and heartbreaking conversations about prognosis and “code status” (a patient’s wish for resuscitation and/or a ven­ tilator), determining which patients’ deaths are imminent enough that they can be allotted their single hour-­ long visit from the loved one of their choice (otherwise, no visitors allowed), and studying textbooks and videos so that I might serve as an ICU critical-­ care doctor should the need arise (which normally would require an extra two years of intensive training beyond the medical education I’ve had). Each day a portion of my list of patients is critically ill, and a portion are recovering. I quiz those who are recovering more extensively about their living conditions than I ever would have before. A single...

A novel use of telemedicine during a hospital mass casualty drill

During a mass casualty disaster drill at NewYork-Presbyterian’s Lower Manhattan Hospital in April 2019, the Emergency Department (ED) used telemedicine to see low-acuity ‘walking wounded’ patients. This telemedicine service is provided every day as ED Express Care Service and staffed by off-site, board-certified Emergency Medicine attending physicians. This novel use of the ED Express Care Service allowed the ED to provide timely, safe, quality care while expanding resources and ED capacity through rapid assessment, treatment and discharge of the low-acuity patients.

Lisa M Schwartz: devoted her career to improving transparency and understanding of medical evidence

Everyone in any way concerned about the state of contemporary medicine will be shocked and dismayed by the untimely death of Lisa Schwartz, professor of medicine and community and family...

Genomic and Geographic Context for the Evolution of High-Risk Carbapenem-Resistant Enterobacter cloacae Complex Clones ST171 and ST78.

ABSTRACTRecent reports have established the escalating threat of carbapenem-resistant Enterobacter cloacae complex (CREC). Here, we demonstrate that CREC has evolved as a highly antibiotic-resistant rather than highly virulent nosocomial pathogen. Applying genomics and Bayesian phylogenetic analyses to a 7-year collection of CREC isolates from a northern Manhattan hospital system and to a large set of publicly available, geographically diverse genomes, we demonstrate clonal spread of a single clone, ST171. We estimate that two major clades of epidemic ST171 diverged prior to 1962, subsequently spreading in parallel from the Northeastern to the Mid-Atlantic and Midwestern United States and demonstrating links to international sites. Acquisition of carbapenem and fluoroquinolone resistance determinants by both clades preceded widespread use of these drugs in the mid-1980s, suggesting that antibiotic pressure contributed substantially to its spread. Despite a unique mobile repertoire, ST171 isolates showed decreased virulence in vitro. While a second clone, ST78, substantially contributed to the emergence of CREC, it encompasses diverse carbapenemase-harboring plasmids, including a potentially hypertransmissible IncN plasmid, also present in other sequence types. Rather than heightened virulence, CREC demonstrates lineage-specific, multifactorial adaptations to nosocomial environments coupled with a unique potential to acquire and disseminate carbapenem resistance genes. These findings indicate a need for robust surveillance efforts that are attentive to the potential for local and international spread of high-risk CREC clones.

Mobile Interventional Stroke Teams Lead to Faster Treatment Times for Thrombectomy in Large Vessel Occlusion.

Endovascular recanalization treatment for acute ischemic stroke is a complex, time-sensitive intervention. Trip-and-treat is an interhospital service delivery model that has not previously been evaluated in the literature and consists of a shared mobile interventional stroke team that travels to primary stroke centers to provide on-site interventional capability. We compared treatment times between the trip-and-treat model and the traditional drip-and-ship model. We performed a retrospective analysis on 86 consecutive eligible patients with acute ischemic stroke secondary to large vessel occlusion who received endovascular treatment at 4 hospitals in Manhattan. Patients were divided into 2 cohorts: trip-and-treat (n=39) and drip-and-ship (n=47). The primary outcome was initial door-to-puncture time, defined as the time between arrival at any hospital and arterial puncture. We also recorded and analyzed the times of last known well, IV-tPA (intravenous tissue-type plasminogen activator) administration, transfer, and reperfusion. Mean initial door-to-puncture time was 143 minutes for trip-and-treat and 222 minutes for drip-and-ship (P<0.0001). Although there was a trend in longer puncture-to-recanalization times for trip-and-treat (P=0.0887), initial door-to-recanalization was nonetheless 79 minutes faster for trip-and-treat (P<0.0001). There was a trend in improved admission-to-discharge change in National Institutes of Health Stroke Scale for trip-and-treat compared with drip-and-ship (P=0.0704). Compared with drip-and-ship, the trip-and-treat model demonstrated shorter treatment times for endovascular therapy in our series. The trip-and-treat model offers a valid alternative to current interhospital stroke transfers in urban environments.

Electronic Surveillance of Surgical Site Infections.

Electronic health and administrative data are increasingly being used for identifying surgical site infections (SSI). We found an unexpectedly high number of patients who could not be classified definitively as having an infection or not. To further explore this, we present an electronic classification algorithm for conservative case finding and identify alterations that would adapt the method for other purposes. Two computer algorithms were created to identify SSI. One model used a strict National Healthcare Safety Network (NHSN) based SSI algorithm, which was applied to all discharges from 443,284 all discharges from four hospitals in Manhattan, NY, 2009 through 2012. The second model used discharges that only had NHSN-defined SSI procedures during the same period. The strict SSI algorithm was able to classify SSI status for 27.3% of discharges; there was a high number of indeterminate cases. In contrast, the modified, less strict model, classified 97.2% of discharges with NHSN-approved SSI procedures. Electronic records provide several options for aiding with the identification of infections in healthcare settings and can be tailored to suit specific uses. While algorithms for SSI classification should reflect the NHSN definition, our research emphasizes how variations of model building can affect the number of indeterminate cases that may necessitate manual review.

Patients' Use of Multiple Hospitals in a Major US City: Implications for Population Management.

Understanding how often patients seek care from multiple hospitals is important for care of individuals and populations, but it is not routinely measured because of lack of data. This study used data from a health information exchange (HIE) to measure the frequency with which patients seek care from multiple hospitals. This was a retrospective cohort study (2010-2011) of all patients who sought emergency department (ED) or inpatient care at 6 participating hospitals in Manhattan. The study found that all 6 hospitals shared patients with each of the other hospitals and that 10.0% of all ED visits and 9.1% of all admissions were for patients who had been seen in a different hospital in the past 12 months. Patients are frequently seen by multiple hospitals, which poses a challenge for clinical care and population management. By capturing which patients are seen where and when, HIEs are well suited for facilitating population management.

Prehospital Indicators for Disaster Preparedness and Response: New York City Emergency Medical Services in Hurricane Sandy.

We aimed to evaluate emergency medical services (EMS) data as disaster metrics and to assess stress in surrounding hospitals and a municipal network after the closure of Bellevue Hospital during Hurricane Sandy in 2012. We retrospectively reviewed EMS activity and call types within New York City's 911 computer-assisted dispatch database from January 1, 2011, to December 31, 2013. We evaluated EMS ambulance transports to individual hospitals during Bellevue's closure and incremental recovery from urgent care capacity, to freestanding emergency department (ED) capability, freestanding ED with 911-receiving designation, and return of inpatient services. A total of 2,877,087 patient transports were available for analysis; a total of 707,593 involved Manhattan hospitals. The 911 ambulance transports disproportionately increased at the 3 closest hospitals by 63.6%, 60.7%, and 37.2%. When Bellevue closed, transports to specific hospitals increased by 45% or more for the following call types: blunt traumatic injury, drugs and alcohol, cardiac conditions, difficulty breathing, "pedestrian struck," unconsciousness, altered mental status, and emotionally disturbed persons. EMS data identified hospitals with disproportionately increased patient loads after Hurricane Sandy. Loss of Bellevue, a public, safety net medical center, produced statistically significant increases in specific types of medical and trauma transports at surrounding hospitals. Focused redeployment of human, economic, and social capital across hospital systems may be required to expedite regional health care systems recovery. (Disaster Med Public Health Preparedness. 2016;10:333-343).

Glove Changing When Handling Money: Observational and Microbiological Analysis

The purpose of this study was to determine the rate of glove changing by mobile food vendors after monetary transactions, and the presence of bacterial contamination on a sample of dollar bills obtained from 25 food vendors near five hospitals in Manhattan, New York City. During 495 monetary transactions observed there were only seven glove changes performed by the workers. Eleven of 34 food workers wore no gloves at all while handling money and food. Nineteen of 25 one-dollar bills collected (76 %) had 400 to 42,000 total bacterial colony-forming units. Colonies were of varied morphology and size. Of these 19 samples, 13 were selected (based on level of growth), and tested for the presence of coliform bacteria, which was found in 10 of the 13 samples. Effective strategies to monitor and increase glove wearing and changing habits of mobile food vendors are needed to reduce risk of foodborne illness.